In rural India, doctors and public health officials aiming to meet family-planning targets set up “sterilization camps” where women arrive by the jeep-loads. They lie on makeshift operating tables while doctors quickly slice open their bellies, insert a laparoscope and tie their fallopian tubes. There are quotas to meet.

The women — who have been enticed by a payment of a few rupees, a free sari or pots and pans – often writhe on the floor in pain after the procedure, and are sent back to their villages with a handful of painkillers and little follow-up care.

Last week, what some activists have criticized as a barbaric system of population control went horribly wrong at an abandoned hospital in the town of Bilaspur in the central Indian state of Chhattisgarh.

There, at least 60 women became sick after botched procedures Saturday at a free mass sterilization camp set up by the district health department. Twelve ultimately died and at least 30 others are in critical condition, state officials said. Four doctors have been suspended and an investigation is underway. Officials said Wednesday that the surgeon performed 83 sterilizations in a little more than five hours, far more than the number recommended by guidelines.

Ram Avtar, who lost his wife Nem Bai during a sterilization surgery, sits with his children in his house in Bilaspur, India, on Nov. 12. (European Pressphoto Agency)

Women who survived the bungled procedures said they felt lucky to be alive and were bewildered by what happened.

Deepa Yadav, 22, who has two children, went to the camp with a relative Saturday for her operation and became ill a few hours later.

“Initially it was fine, but within a few hours I developed severe pain and started vomiting. I lost consciousness,” Yadav said. Relatives took her to a hospital. “I don’t know what went wrong. Many women from our neighborhood have done this surgery before but such a thing never happened.”

She received 1,400 rupees, or about $22, to undergo the procedure.

Sterilization is by far the most common method of family planning in India, government records show, with 37 percent of married women sterilized, according to the country’s National Family Health Survey. Although the national government says it no longer sets targets for the number of women sterilized, unofficial goals still exist, said Avina Sarna, the director of Population Council of India. A “motivator,” usually a local public health worker, is paid 200 rupees (about $3.25) per head to bring a woman or a man to a camp for sterilization.

Mihir Banerjee, vice president of People for Better Treatment, an organization fighting medical negligence in India, said such camps prey on illiterate, low-income women who have no recourse when procedures go wrong.

“They conduct surgeries en masse in the most horrible conditions without caring for the safety of the patients,” Banerjee said.

Relatives mourn the death of women who died after undergoing sterilization surgeries at a village near Bilaspur, in the central Indian state of Chhattisgarh, on Nov. 11. (AP)

This common birth control method has a difficult political history in India. The Indian government first began family planning initiatives in the 1950s. But forced sterilization for men to control a population boom in the 1970s — launched by Indira Gandhi’s government — led to a nasty backlash.

That troubled period set back government family planning efforts for decades. It reemerged later as “family welfare” — with the government health ministry offering an array of birth control options, including condoms, pills and intrauterine devices.

The efforts have lowered the fertility rate to 2.4 children in 2011, from 3.6 in 1996, government statistics say. Yet more work is needed to stabilize population growth in a country of more than 1.2 billion that still adds 16 million people a year, according to the U.N. Population Fund.

Many health and women’s activists have long criticized the government’s over-emphasis on sterilization, saying it is a lazy way out of the labor-intensive work of sending counselors to villages to educate people on the benefits of smaller families or regularly handing out birth-control pills and condoms.

Sarna said that family planning advocates had hoped that the government would further expand contraceptive options provided through its public health system, such as injectables or implants.

“It’s time for us to be able to provide a bigger choice and wider choice to women,” she said. “An incident like this will be a setback to the agenda because of the bad publicity it brings. It’s unfortunate. If women need to worry about dying, they’re not going to come” for family planning.

Meanwhile, the investigation of what happened in the sterilization camp in Bilaspur is underway, said Siddharth Komal Pardeshi, the town’s district collector.

“It would be premature to comment on the cause of death or what exactly went wrong,” he said. “We are now focusing on the treatment of the sick women.”

Rama Lakshmi and Jalees Andrabi contributed to this report.

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